Category Archives: Brainblogger

This particular article is inspired by my perusal of Lt. Col. Dave Grossman’s “On Killing: The Psychological Cost of Learning to Kill in War and Society” and “Shooting Ghosts” by Thomas J. Brennan and Finbarr O’Reilly. I am a retired clinical psychologist and psychology professor. I also served as an Air Force medic during the Vietnam Conflict. I did not serve “in country”. I served as a medic at Andrews AFB in the emergency room of Malcolm Grow Medical Center. There I witnessed considerable physical trauma. I witnessed death on a number of occasions, some violent, some peaceful. I remember the violent ones.

I also served temporary duty (TDY) at Lackland AFB working with airman stationed in Vietnam, presenting with PTSD and substance abuse disorder (SUD). As a clinician in Behavioral Health Care, I dealt with folks presenting with multiple psychosocial trauma, including combat Vets from Vietnam.

I’ve not witnessed directly the ghosts of combat. Those who have repeatedly are haunted by those of comrades killed (KIA) and by those who they killed, especially those who are civilians. Thus, they experience what I refer to as “compacted grief”. During war, there is little room and energy to grieve.

I completely agree with Lt. Col. Grossman that most of us possess a natural inclination to not kill other humans. No amount of combat training can prepare soldiers for the realities of war and combat. I see war as an extreme expression of insanity, even when war is deemed by some to be necessary and the participants are “voluntary”. War and combat sear us at the limbic level, a necessary encounter which I refer to as “Dark Beast”. The Vets I have treated and my many clients in BHC have taught me so much about this Beast. The following account here centers on my running commentary as I read “Shooting Ghosts”, using my observing clinical ego.

When I embarked on reading their candid descriptions of encountering repeated episodes of violent death, At times I felt guilty for not having served in Vietnam. I joined the Air Force after my college deferment lapsed once I graduated. I did not really support our endeavor there. I never felt this Conflict to be an urgent and immediate threat to our nation’s integrity. I became a medic so that I would not have to kill anyone, nor would anyone would be killing me. I did therapy with some of the field medics who were confronted with killing. Killing is counterintuitive to our ethical oath to: above all else, do no harm.

From Chapter One, I disagree that “Misfits Go to War”. We join the military for a number of reasons. For the most part, the Armed Forces want servicemen with integrity who join for a higher purpose like serving our country and protecting others. The bonds forged with comrades begin during advanced training and intensifies early in deployment. Individual survival is directly associated within this group that we refer to as our squad. It is this commitment that soldiers go into battle and come back as a group which I refer to as “affiliative aggression”. Soldiers are protecting one another!

The second disagreement is that war and journalism do mix in order to inform the rest of us about the horrors and terrors of war, and the tremendous cost borne by those who directly experience it. And none of us are “fearless and invincible”. In fact, my professional experiences assure me that life is quite precious and tenuous at the same time; so we dearly need to hold onto it! And guns and cameras are valuable tools of the respective trades.

Chapter Three: Ambushed

Now it is kill or be killed by the enemy. Affiliative and defensive aggression is rising. They sustain some injuries and every squad member returns to their outpost. No time for “mental casualties”; the BB is really present for the first time! An RPG creates a concussion suffered by the squad leader. Back at the outpost “Air Force medics” come to the rescue. Everyone is alive, but are they really? Concussions are quite serious. Each skirmish does not change the outcome of the war; yet indeed changes those who participate!

Chapter Four: Walking Wounded

The human brain consists of about One Trillion nerve cells, and about ½ of our genome is dedicated to the form and function of this organ. Sounds like a lot and many that can be spared. Indeed, the brain is well known for its neuroplasticity! I’m uncertain as well if God has or has not allowed us to contemplate going to war let alone engage in it. Traumatic Brain Injury (TBI) also occurred in Vietnam, not just in our more recent conflicts. Perhaps it is garnering more clinical attention? We know that it is also intimately related to Clinical Depression and PTSD. I agree that repeated combat encounters result in a “kinship and loyalty” that many of us will never know!

Chapter Five: The in-between

The brain and all of our human senses process all of our internal and external experiences. I refer to the brain as a “master accountant”. Much of what we process occurs beneath our conscious awareness.

In fact, there are at least seven streams of awareness. Some are deeply embedded suggesting that we better remember certain experiences more than others to ensure our survival.

Those in combat continue to experience the traumas once confronted repeatedly by the DB! Being back “home” and away from the front lines does not matter. We are genetically primed by our “threat alarm” in responding to perceived and/or real threats by fighting, fleeing, or freezing. Our primary cognitive processes regarding threats pertain to harm, loss, and challenge. We must not ignore them!

Even photographers and journalists are not immune to being harmed or killed! Immunity from stress and trauma is indeed an “illusion”. During adolescence, males exhibit an increase of invincibility (probably due to the significant infusion of testosterone). And there is no “magical cure” for real trauma. And life is more important than what each of us do for a living.

Chapter Six: Human Triggers

Another death of a platoon member, who is very experienced in combat; and he is survived by a wife and children, gets a lot of attention. His loss impacts more than this soldiers. And indeed death is all around as the “Dark Beast” possesses an insatiable appetite for “kills and body counts”.

The effects of TBI on the squad leader are apparent. And there is no room for complacency and lapses of concentration! They are becoming human targets and increasingly aware of this reality. The sights, smells, and sounds of violent death are deeply etched in the collective minds of these soldiers. Home for them seems a long way off! The platoon leader earns a Purple Heart. And he feels he doesn’t deserve it. So far, he and his men are alive.

Chapter Seven: Lost Limbs and Skull Tattoos

Another photographer is severely injured having stepped on an IED. It is natural to “dread” the “damaged cargo” carried by the MEDEVAC choppers. Some photojournalists become resigned to this possible occupational fate. There is a growing sense that these soldiers may not ever win the “hearts and minds” of the Afghan civilians despite their best efforts to do so.

Some of the violence and deaths of comrades that these soldiers experience are etched on the largest sense organ—the skin. No time to deal with any of this in a combat zone, no time to grieve! Suppression of trauma from previous combat excursions does not work either! And the photojournalist embedded with this squad begins to question his witness position and “feels predatory, repulsive, and a betrayal of human decency”.

Chapter Fourteen: Coming Undone

The home front is becoming undone. Interpersonal relationships are becoming frazzled. The natural regression after repeated exposure to the “Dark Beast” is taking its toll. All the prescribed psychotropics (chemical cocktails) in the world won’t make that much difference. BTW suicide among combat vets is rising despite priority efforts to prevent them.

Chapter Sixteen: Echoes of Iraq

The Boston Marathon bombing reawakens images of the “DB” on US soil for the second time since the attack on 9-11. Surely there is no safety and security now! Understandably, cemeteries and headstones serve as triggers. For soldiers converting back to civilian life, there exists a natural disconnect between military culture and the civilian role; clinicians refer to this as cognitive dissonance, and it penetrates much deeper than just our thinking!

Advanced combat training does not really train soldiers to kill the designated enemy, only the illusion of them. And the military certainly does not prepare them to kill civilians such as children, women, and the aged. Yet, this happens in actual combat. For example, during the Vietnam Conflict, it is estimated that more civilians were killed than enemy combatants on both sides. This distinction gets lost in the insanity of combat. Yet the civilian-soldier has to come to terms with this reality; and based on having conducted psychotherapy with Vietnam combat Vets, the grief and regret become almost unbearable! I refer to this state as psychosocial death. Sociologist, Erving Goffman, refers to this as “mortification”. Killing the innocent does not reflect affiliative or defensive aggression. To me, it is an adverse consequence of encounters with the “Dark Beast”.

Final Thoughts and Observations

First of all, I express my sincere gratitude to all those who have, do now, and will serve in the Armed Forces; and my gratitude to all the loved ones who endure this journey with them. I want you all to know, that in my clinical view, soldiers do what they do out of affiliative and defensive aggression; they are not predators!

Those who send humans to war need to examine much more closely the human damage done to the participants and family members for whatever gains are earned in doing so.

And it is my clinical observation that group counseling/therapy could be more efficacious in treating those who are haunted by the ghosts of combat. Group therapy can recapitulate the crucial military unit- the squad. This offers a better opportunity for some healing from the repeated exposure to the “Dark Beast”.

In the age of social media, networking and global never-ending communication, introverts are often viewed as rather inefficient. They are considered as people who would not happily express their opinion during the staff meetings or actively participate in brainstorming sessions. They are often considered to not be good at multitasking or be particularly charismatic. They are rarely at the center of attention at a party, and they often ignore their smartphones for hours in a row. These days, when we believe that big tasks require the active participation of large groups of people working together, being an introvert could come as a disadvantage.

But don’t discard introverts altogether: some of the most successful people in the world are introverts. Albert Einstein, Bill Gates, and even social media inventor Mark Zuckerberg are all self-confessed introverts. So how do these people who apparently lack some of the basic skills needed for a successful career manage to achieve so much? What makes the brain of an introvert so different and so special?

Being a loner has its upsides and downsides when it comes to health and success

It is well known that personality traits are not just the result of social conditioning – they have more to do with the genetics and brain structure. People are born or inherit specific personality traits quite like they inherit any particular physical parameters and characteristics. These personality traits bring their advantages and disadvantages. Studies have also demonstrated the anatomical difference between the introvert and extrovert brain. Imaging studies have shown the differences in both the grey matter and the white matter volumes in the various parts of the brain, thus confirming that personality traits are hard-wired into the brain.

Introverts do not like prolonged social interactions, and they feel uncomfortable in large social gatherings. Introverts don’t mind remaining isolated for extended periods. They love to think and dream. However, this self-imposed social isolation comes at a price. Lower social interaction increases the risk of certain disorders; it may negatively affect cognitive functioning, increase the risk of metabolic disorders, and negatively impact the immune system.

Extreme social isolation and its negative consequences are well studied. People living in orphanages or imprisoned for prolonged periods may go through periods of mental instability, and some may even experience hallucinations. However, being introverts is different, and self-imposed social isolation may not necessarily indicate idle brain or lack of resilience towards these health issues. The latest research studies show that these periods of being alone may have positive impacts on emotional and work life.

Focus on creativity

One of the benefits of being more focused on own thoughts is the improved creativity. Introverts are more open to different ideas; they may have a higher level of confidence and independence. Introverts are less concerned about what others may think. Studies have shown that prominent feature of both scientists and artists is the dislike for too much of social interaction: avoiding it leaves them with more time to focus on their ideas.

Introverts have more time to perfect their crafts than those who spend most of the time socializing. They have time to make sense of their thoughts and experiences. All this means that they have higher chances of achieving a eureka moment.

However, it should be understood that not every kind of social withdrawal is the same. Some type of non-socializing is an indicator of psychological and physical health issues. Social withdrawal may be due to shyness and anxiety, or it may be due to a dislike of socializing. Both may have a negative impact on health and would not necessarily better the creativity. On the other hand, those who socialize less just by choice (rather than due to anxiety or dislike) are more probable to be healthy and creative.

These findings are important, as earlier it was believed that unsociability can be harmful. Now the researchers demonstrated that unsociability might be even beneficial. Healthy introverts prefer to spend more time alone, but this does not mean a complete social withdrawal. They would usually have just enough of social interaction. Creative people prefer being alone, and at the same time, they spend enough time in the company of others.

The researchers also noticed that cultural differences may play an important role too. For instance, unsociable children in China had more academic problems in comparison to their Western counterparts. However, this difference is becoming less visible due to globalization.

There is a general belief that specific profession demand more sociable personality and extroverts are better in the leadership roles. However, this is not always accurate, and research shows that a lot depends on the collective nature of the employees. Introvert bosses are more successful if the employees are more sociable. On the other hand, extrovert bosses are better in a leadership role if the employees are less proactive.

Meditation, hermits, and health

If we look back into the human history, we understand that self-imposed isolation was commonly practiced by individual members of society. Hermits would practice solitude to achieve nirvana. Daydreaming in the absence of social interactions activates the so-called default mode of the brain. Thus, isolation helps in consolidating the memories and emotions, at least to a certain extent. Isolation helps a person in re-organizing thoughts. Interestingly, when people come out of self-imposed isolation, they are likely to socialize better and more effectively.

Researchers also warn that the boundary between the dangerous isolation and useful solitude is quite blurry. Extreme loneliness could be somewhat harmful or indicative of poor health. Practicing solitude to stay productive and creative does not mean being completely unsocial. On the other hand, there is a real danger for the physical and mental health of those who are never alone. Furthermore, research indicates that introverts have fewer but stronger bonds with others that lead to better satisfaction in life and greater happiness.

If a person does not like to socialize too much, there is nothing wrong with him or her. It is important that the solitude is a person’s choice and not forced upon him/her: even the classical introverts need few good friends.

In humans, vision is the major channel for receiving information about the world. The same applies to the majority of animals, even those that are nocturnal and have to rely more heavily on the inputs from other senses. There are, however, exceptions: some mammals use echolocation to construct a picture of their surroundings, effectively using it instead of vision. How effective is this method of gathering information, and can it substitute vision successfully?

Echolocation

Echolocation is used by several kinds of animals for navigation in various environments. Whales, dolphins, and bats emit calls (high-frequency sounds) and then listen to the echoes returned from different objects surrounding them. The distance to objects can be estimated based on the time delay between the production of the call (click) and detection of the echo. Since the sound travels in the air with the speed of 340 m/s, a delay of 2 milliseconds, for instance, would mean that the object/target is about 34 cm away. In addition, sounds travel faster in water than in the air, making the clicking signals produced by whales of shorter duration than the signals produced by bats. Some echolocation signals produced by dolphins and sperm whales are even audible to humans.

Echolocation and its importance in the animal kingdom have been widely studied. Nature provides remarkable examples of how efficient echolocation can be. Bats easily detect tiny insects several meters away in complete darkness. Some species of bats in China and South America can fish in the darkness using echolocation, detecting ripples on the water surface that are indicative of the presence of fish under the surface. Sperm whales use echolocation to find and catch prey, mostly giant squids, deep in the ocean. These whales can dive to the depth of well over 2 kilometers and navigate through underwater canyons where their prey lives.

Although echolocation can be very efficient, it is not particularly common in the animal kingdom and was, in fact, developed independently by several groups of evolutionarily unrelated species. This is markedly different from vision, which is present in the majority of animals, with mechanisms perfected over millions of years of uninterrupted evolution.

Echolocation and Vision in Bats

If echolocation delivers essentially the same information as vision, can echolocation rely on the brain processes related to the processing of visual information?

To answer this question, scientists have investigated brain mechanisms underlying the processing of echo signals that allow animals to map objects in term of distance and direction.

Recently, an interesting study was conducted in bats with the aim of revealing what is happening in their brain while they fly through a room filled with obstacles (i.e., acoustically reflective plastic cylinders hanging from the ceiling). In order to determine the mechanisms underlying the bats’ navigation around these obstacles, researchers performed simultaneous chronological neural recordings.

The results show that the bats adjusted their flight and sonar behavior in order to respond to the echoes coming from the objects in the room. The objects’ positions were changing across the recording sessions, and bats started their flight from different start points to make sure that they didn’t rely on spatial memory from previous sessions and used only echo feedback to navigate.

The most important finding was the identification of the brain region that helped the animals to locate the objects in their environment. Echolocation signals were processed in the superior colliculus, a structure located in the midbrain. The superior colliculus consists of several layers that respond to different kinds of stimuli. Deeper layers of the superior colliculus are known to be involved in the processing of visual information. Thus, it seems that echolocation may indeed help animals to obtain a picture of their environment that is as authentic as the picture received through visual channels.

Echolocation and Vision in Humans

According to scientists, echolocation is not a phenomenon completely alien to humans. It seems that some blind individuals can be trained in echolocation.

Using this technique, they can locate objects by generating mouth clicks and listening to their echoes. The returned echoes can provide them with important information such as position, distance to and even the size or shape of the objects.

Several studies were conducted in order to determine the underlying neural mechanisms involved in human echolocation. One study investigated two individuals skilled in echolocation, one early and one late blind. The authors of the study measured brain activity in both participants while they were listening to their own echo sounds. They compared brain activity with clicks that produced echoes with the brain activity of control sounds that did not result in echoes.

It turned out that the processing of echo sounds activates brain regions that are typically associated with vision rather than hearing. More specifically, echo signals were processed in the visual cortex (rather than in superior colliculus like in bats and other echolocating animals). However, the processing of visual information in humans is centered around the visual cortex rather than the superior colliculus, as the human visual cortex has significantly expanded compared to most animals.

Thus, in both animals and humans, the information received through echolocation is processed in those regions that are also predominantly responsible for the processing of visual information. The curious examples of human echolocation are a perfect illustration of the plasticity of our brain and its ability to adapt to changing circumstances (blindness in this case).

A recent publication on echolocation in humans reviewed the applications of this phenomenon as well as the processes occurring in the brain of echolocation experts (i.e., individuals that are skilled in echolocation). They have reported that echolocation may enable blind people to sense small variations in the location, size, and shape of objects, or even to distinguish different materials the objects are made of, simply by listening to the echoes of their own mouth clicks.

It seems that echolocation may be perfected by blind individuals to facilitate the handling of daily tasks and achieving a higher degree of independence. Based on neuroimaging studies, the review confirmed that the processing of input signals from echoes activates the visual cortex, a brain part that would normally support vision in the sighted brain.

Addictive behavior is a major global health concern. Addiction is commonly defined as the repetitive use of substances or a repetitive pattern of behaviors that are harmful. It is believed that addiction is a brain disorder, meaning that it is caused by the impact of drugs or other addictive substances/influences on the brain and it can be modified by different environmental factors.

The presence of specific variants of some genes may promote or decrease the chances of developing an addiction. According to scientists, genetic factors may play an important role in determining both the vulnerability to addiction and the response to treatments aimed to cure addiction.

The Brain and Genetics in Addictive Behavior

One group of researchers demonstrated that polymorphisms in the genes encoding for opioid receptors and opioid ligands, and more specifically the MOPR gene (OPRM1), is associated with drug addiction. It has been found that one variant of this gene contributes to alcoholism and heroin addiction.

Another study has found that carriers of the same gene variant experience a more pronounced sensitivity to pain and decreased analgesic response to opioids, which means that they require higher doses of morphine in the management of pain, such as pain associated with cancer.

Heroin and Opioids

Some authors underlined that addiction to MOPR agonists, including heroin, has become epidemic in the 21st century. According to the same authors, the endogenous opioid system interacts with other neurotransmitter systems in the brain. More precisely, opioid receptors regulate the release of dopamine and serotonin, neurotransmitters with important roles in mood.

Additionally, the opioid system seems to interact with noradrenergic, GABAergic, and glutamatergic pathways, as well as with neural growth factors. Furthermore, these studies indicate that chronic exposure to opiates alters gene expression in the brain, and this causes long-term changes in neuronal networks.

Activation of opioid receptors leads to changes in the expression of genes in the above-mentioned neurotransmitter pathways. Variations in the genes of those pathways may determine whether someone is more prone to the development of opiate addiction.

Cocaine

One very recent study published this year revealed that the use of cocaine and cocaine addiction are associated with certain variants of the glucocorticoid receptor gene, along with lower expression of this gene.

More specifically, the authors of the study compared the expression level of this gene in chronic cocaine users and healthy controls. Apart from significantly lower gene expression in the cocaine users, the carriers of some gene variants were at increased risk of cocaine addiction. In addition, they scored higher on depression scales.

Dopamine

It seems that the major challenge in understanding and treating addictive disorders is understanding why some individuals develop addiction while others do not. According to research findings, whether or not a person will become addicted depends largely on genetic factors, which contribute ~50% of the risk for addiction.

The processes in our brain are also important. It is well established that the rewarding effects of drugs and addictive substances, in general, are based on their ability to increase the level of dopamine in the brain. Accordingly, imaging studies have shown that individual variations in brain circuits modulated by dopamine, including circuits involved in the mechanisms of reward, contribute to the inter-individual variability in the vulnerability to addiction. Thus, it seems that the roles of genetic factors and brain pathways in the addiction may be intertwined via dopamine.

Alcohol and tobacco

Apart from drug addiction, addiction to alcohol seems to depend on genetics and is influenced by heritage. A recent study has investigated the effects of parental drinking on the use of alcohol in young adults. More than 3500 adolescents and their parents have been included in this prospective research. As results have indicated, young adults whose parents are moderate or high alcohol consumers are more prone to alcohol consumption than those young adults whose parents don’t consume alcohol or consume it in low quantities.

Alcohol and tobacco use represent leading global health risks, which are responsible for 3.3 and 6 million premature deaths per year respectively, according to the World Health Organization. Genetic factors were estimated to contribute 40-60% and 40-85% to the development of alcohol and tobacco addictions respectively.

Finding out which genetic variants are associated with alcohol and tobacco addictions would be an important step in understanding their underlying mechanisms and developing the effective therapies. Over the last years, Genome-Wide Association Studies (GWAS) have been performed in order to elucidate the role of certain genes and their variants in alcohol and tobacco use. These studies have recognized that single nucleotide polymorphisms (SNP, i.e., gene variants with a difference in a single nucleotide) are important for developing these addictions.

For alcohol addiction, SNPs include polymorphisms in the KLB gene, as well as in the alcohol dehydrogenase gene cluster. In the latter, different variations of genes differently influence the metabolism of alcohol. In the case of tobacco use, the most evident variations have been detected in the nicotinic acetylcholine receptor subunit genes cluster.

However, only a small number of common genetic variants have been studied, and they account for a modest proportion of alcohol and nicotine addiction heritability. Thus, further investigation into the role of low frequency and rare genetic variants is required in order to fully understand the heritability of both alcohol and tobacco use.

In Sum

Considering all of these facts together, it seems that genetics does indeed play an important role in the development of addiction to substances such as opioids, alcohol, and tobacco. Some of these factors include differences in gene expression and gene variants in brain neurotransmitter pathways. Further research is needed in order to develop working strategies for treating heritable addictions.

Cancer is one of the top leading causes of mortality globally. The growing prevalence of the disease has to do with both our changing environment and longer lifespan. It is said that if all humans lived for 200 years, most people would develop cancer at some time in life. Thus, finding a cure for cancer is vital for longevity

Cancer is the unregulated growth of one or another type of cells. In the case of glioblastoma, it is the unchecked growth of glial cells in the brain. Fortunately, brain cancers are less common in comparison than those found in other parts of the body. However, when they occur, they are difficult to treat.

Glial cells are a group of cells that have varied functions in the brain. In the past, they were thought to merely be glue cells that help to keep neurons at the place. But now it is understood that glial cells have many other functions, and help to maintain brain health. They do the cleaning, repair, and maintenance, and also play a role in the local immunity.

A glioblastoma is a rare form of cancer—its occurrence is about 10 in 100,000. Among the brain cancers, however, glioblastomas account for 15% of all cases. It is one of the most aggressive types of brain cancers. Thus, even with the best of treatment, most patients will barely survive one and a half years. Very small numbers of patients can expect to live longer than three years, and less than 5% live up to 5 years.

Despite the progress in the treatment and management of other forms of cancer, only a few positive glioblastoma treatment developments were reported in the last decades. For more than half a century, treatment of brain cancers remains based on surgery and chemotherapy. Usually, the surgeon would remove the affected part of the brain, and then they would try to suppress the remaining cancer cell with highly toxic chemotherapeutic agents. This approach has not been working well for glioblastoma.

These days, thanks to advancements in personalized medicine and a better understanding of cellular physiology and genetics, newer cancer treatments are being developed. Instead of mere surgical removal or the use of toxic drugs, researchers are learning ways to control various cellular mechanisms. Using these novel methods, it is possible now to force the brain tumor into remission or train the brain’s immune system to work against cancer.

Exploiting what forces cancer into remission

Genes and various factors control every part of cellular life. Thus, cells grow in a particular fashion, behave in a specific way and, when required, go through programmed cell death. In the case of glial cells, this programmed cell death is called anoikis. Further, to keep the brain functioning, these supportive cells also engage in autophagy. Autophagy is a process that helps to keep the brain clear of debris and unnecessary components.

Autophagy can be both protective and dangerous to brain cells. Autophagy helps cancerous glioma stem cells resist anoikis. Autophagy is now known to be regulated by the MDA-9/Syntenin gene. Researchers have found that when the MDA-9/Syntenin gene is blocked, the glioma stem cells lose their protective ability and succumb to programmed death (i.e., anoikis).

Further, researchers found that MDA-9/Syntenin gene suppresses epidermal growth factor receptor (EGFR) signaling. Excessive EGFR signaling has been found to be associated with brain cancer/glioblastoma. EGFR is protective against excessive autophagy or programmed cell death.

Scientists realized that when the MDA-9/Syntenin gene is blocked, EGFR cannot regulate protective autophagy, and more widespread death of cancer cells ensues. Now, researchers want to use this feature in a controlled manner to kill the cancer cells.

At present, this approach is being tested in laboratory models of tumor cells and in mouse models. Initial results seem to be encouraging. Suppression of the MDA-9/Syntenin gene in mouse models led to higher survival rates.

Researchers are confident that in the near future they will be able to find safer ways to suppress the MDA-9/Syntenin gene in humans and then start trials on people diagnosed with glioblastoma.

Training immune system to destroy cancer cells

This is another approach towards the treatment of various types of cancers. Clinical research has already shown the efficacy of this approach in glioblastoma and many other types of cancers. This approach involves creating an individualized or personal vaccine for each patient with glioblastoma. The initial human trials have already shown a better survival rate.

When it comes to creating a vaccine against cancer, one size does not fit all. The reason is simple; each cancer patient differs genetically. This difference in each cancer patient is linked to the fact that cancers develop due to different mutations across individuals. It means that all patients with glioblastoma have slightly different types of tumor. Therefore, one single vaccine would not work.

The answer to these patient-specific cancerous mutations is a personalized vaccine. This vaccine is called DCVax-L. The vaccine is created by extracting cancer cells from individuals and then training the dendritic cells of the immune system to fight against those specific mutations or cancer cells. Each patient who gets this vaccine would first go through the traditional surgical and chemotherapeutic treatments. Upon completion of these treatments, the patients would receive the vaccines created specifically for them, to prolong life.

Good news is that this method is already in the last stages of development, and it has shown excellent results in a randomized, blind clinical trial. In these trials, the DCVax-L vaccine was given to 232 patients at various sites. This trial has not yet ended, but the initial results clearly show the higher survival rate. Around 30% of those who got this vaccine survived more than 30 months, and one-fourth survived more than 36 months. At present, 32.6% of those enrolled in the trial are still alive, and they are expected to live between 46.5 to 88.2 months. At present, the vaccine is not a curative treatment, but it provides serious benefits in comparison to traditional methods.

It has taken more than two decades to perfect the vaccine, and researchers believe that things will only get better in the future. In the very near future, we can expect to see much higher 5-year survival rates for glioblastoma patients, and that would already mark a big success.

Jäkel, S., & Dimou, L. (2017). Glial Cells and Their Function in the Adult Brain: A Journey through the History of Their Ablation. Frontiers in Cellular Neuroscience, 11. https://doi.org/10.3389/fncel.2017.00024

In 2017, Mental Health America reported that one in five adults with mental illness say that they are not receiving the mental health care that they need. (Mental Health America, 2017) The reasons for this are the following:

There is one mental health care provider for every 529 individuals in the US. This gap widens significantly for specialized mental health care. Only 20% of children with mental health problems receive some form of mental health services. The reason is that there are only about 8000 child and adolescent psychiatrists practicing in the US. In San Francisco alone, the Center for Disease Controls and Prevention (CDC) reports that there are about 32 child psychiatrists and 88 child psychologists per 10,000 children ages 0 to 17 years old.

There is a need for re-imagining the delivery of mental health care. One such method is known as the Friendship Bench Intervention (see video). The friendship bench has been undergoing development for more than 20 years in Harare, Zimbabwe where the Harare City Health Department in collaboration with the University of Zimbabwe Medical School sought to solve a major cause of disability from non-communicable diseases in the region, mostly common mental disorders such as depression and suicidal ideation.

The Friendship Bench is a task-shifted brief intervention and problem-solving therapy for common mental disorders which is provided by female lay health workers trained in specific aspects of cognitive behavioral therapy, particularly in problem-solving therapy and behavior scheduling.

In short, the Friendship Bench mitigates common mental disorders such as depression by utilizing female lay health workers who are trained and supervised by clinical psychologists and psychiatrists to perform problem-solving therapy in a primary care setting.

The problem-solving approach starts with the patient identifying the cause of his mental illness. For example, unemployment. Interestingly, this approach deviates from the conventional where experts aim at diagnosing the patient from the symptoms that they present. Problem-solving therapy aims to provide a positive orientation of the patient towards resolving these identified problems. This makes them realize that they can have control in overcoming their mental illness.

The lay workers follow a script and conduct 6 sessions lasting from 30 to 45 minutes for each patient. The first session involves three components: (1) Opening the Mind or kuvhura pfungwa, (2) Uplifting or kusimudzira, and (3) Strengthening or kusimbisa. The first session aims to let the patient open their mind and identify their problems. They would then be allowed to choose only one to work on. The lay worker and the patient will then identify how to solve this problem realistically and formulate an action plan. This is an iterative process where the subsequent sessions will develop based on the first session.

Hiring and training lay workers from the community can significantly increase the mental health workforce. The requirement for the adult female trainees in this program is an educational background with at least 8 years of formal schooling (secondary schooling may suffice). The average age of the trainees is 58-years old. The training can be easily implemented, and it is cost-efficient at only $200 per health worker.

Community engagement is a key process in the development of the Friendship Bench. The goal is to bring community members, experts, researchers, and other key stakeholders together and become equal partners in the program. They engage in a workshop to develop a theory-driven framework known as the Theory of Change. Members hypothesize the best treatment initiative plan for the community’s patients and form a theory of “how and why an initiative works?”. Variables are identified and constantly measured for every cause and effect pathway. This illustrates proof that an initiative has a positive or negative impact. The theories are continuously measured, challenged, and changed until the desired impact is formulated (see Figure 1).

The success of the program is heavily reliant on the training method, the translation of the manual to the local language, and the integration of the program with the culture of the community. Lay workers must also learn how to translate and utilize tools used in common mental disorders such as the 20 item Self-Reporting Questionnaire (SRQ-20), General Health Questionnaire (GHQ-12), Hospital Anxiety and Depression Scale (HADS-D), and Patient Health Questionnaire – 9 Depression Test (PHQ-9). These are the basic metrics used to determine if the therapies are working.

Adding to the workforce, competent lay mental health workers in the primary care setting can offset the gap in mental healthcare delivery in communities. Its success in first-world countries is more likely because its growth can be sustained by leveraging readily accessible financial resources allocated each year by public health organizations. Its robust infrastructure, particularly in primary care clinics and information technology such as telehealth services, can boost the Friendship Bench programs. A limitation of the FriendshipBench is that it is designed to treat adult common mental disorders. To emulate this program so that it can suit the need for pediatric mental health disorders is of importance.

Center for Disease Controls. (2015). Behavioral Health Services Providers by County. Retrieved May 15, 2018, from Centers for Disease Control and Prevention: https://ift.tt/2KOefmV

Chibanda, D., Mesu, P., Kajawu, L., Cowan, F., Araya, R., & Abas, M. A. (2011, October 26). Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. DMC Public Health, 11, 828. doi:10.1186/1471-2458-11-828

Falling Through the Cracks in Pain Management

Pain and Opioids

Chronic pain is debilitating, and it can cause patients to “fall through the cracks”. Health care institutions struggle to find ways to create “nets” and catch these patients. Pain medications include opioids which are used to treat chronic pain. Opioids often fail to treat the patient’s primary medical condition. As time goes by, patients tend to be unsatisfied with the results.

Also, there is a good chance that some of these types of pain medications will be abused. In fact, pain medicines such as opioids are part of the United States opioid crisis. According to the Centers for Disease Control (CDC), every day, more than 115 people in the United States die after overdosing on opioids. (CDC/NCHS, 2017) The opioids include prescription drugs, including fentanyl, and synthetic street drugs such as heroin.

It is estimated that the total economic burden of prescription opioid misuse in the United States is $78.5 billion a year which includes the costs in health care, lost productivity, addiction therapy, and criminal justice involvement. (Florence, Zhou, Lou, & Xu, 2013)

Pain and Mindfulness Meditation

To overcome pain, another task which demands higher controlled attention must be pitted against it.

One such therapy is known as mindfulness meditation. Mindfulness meditation is: “the intentional self-regulation of attention from moment to moment”. (Goleman & Schwartz, 1876) This method has been used for quite some time. A study done in mindfulness meditation by Dr. Kabat-Zinn has reported that 65% of patients have exhibited a reduction of pain by more than 33% and about 50% of patients have reported a reduction of pain by 50% over a 10-week period of therapy. (Kabat-Zinn, 1982)

Some studies performed in mindfulness meditation have reported patients with strong feelings of anger towards their pain condition while others report some anxiety while undergoing mindfulness therapy. la Cour and Petersen point out that meditation therapy requires a learning curve for the patient to access the more important personal “inner space”. (la Cour & Petersen, 2015) This can be an exciting learning experience of discovery for some patients while other patients may see this as a constant battle that in itself can be a painful experience.

The next question to consider therefore is to find out which patients benefits the most from mindfulness meditation and which are not, and then find out what other therapies we can use in these patients.

Enter Virtual Reality: Pain and Attention

Recall a recent injury. Ever wonder why after a trauma or injury has occurred, there seems to be a delay in which actual pain is produced? Pain has to first gain access to consciousness and demands central attentional resources by interrupting all other current brain processes such as worry, fear, or desire. It does so easily because of its noxious nature. (Eccleston, 1995) Pain, therefore, can be considered as a controlled task. To overcome pain, another task which demands higher controlled attention must be pitted against it.

The characteristics of pain such as intensity, quality, and/or pattern affect the probability of capturing attention. In chronic pain, for example, the characteristics of the pain and its intensity are important for pain processing. This may explain the reason why there are “good” days and “bad” days for patients with sciatica, multiple sclerosis, and other causes of chronic pain. Persistent pains with unpredictable sensory qualities that fluctuate in intensities are more likely to be processed. (Eccleston, 1995)

Finding the perfect distractor with the ability to interrupt persistent pain stimulus processing is key to coping. Virtual reality (VR) systems offer computer-generated sensory inputs that involve sight, sound, and touch. These inputs make it essentially difficult for the brain to ignore especially if the VR program is immersive. Immersive VR is an experience that gives a perfect illusion to the patient that is in the virtual world. The strength of the illusion of the presence of the virtual world reflects the amount of attention drawn into the virtual environment. (Hoffman, Doctor, Patterson, Carrougher, & Furness III, 2000)

Virtual reality may not replace the conventional pain management anytime soon. Once the patient comes out of VR, they will soon feel pain once more. Pharmacologic therapy remains the mainstay of pain management. But the problem of using pharmacologic treatment for pain remains a challenge. Undermedication is a problem of pain management failure. But higher doses of opioids poses a serious risk such as respiratory failure and encephalopathy. Therefore, the application of pain relief using VR may be for the use of procedural pain management such as minor surgical procedures, wound cleaning and debridement, and escharotomy in burn victims.

Eccleston, C. (1995). Chronic pain and distraction: an experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. Behav Res Ther, 33(4), 391-405. doi:10.1016/0005-7967(94)00057-Q

Color vision is the ability to distinguish different wavelengths of electromagnetic radiation. Color vision relies on a brain perception mechanism that treats light with different wavelengths as different visual stimuli (e.g., colors). Usual color insensitive photoreceptors (the rods in human eyes) only react to the presence or absence of light and do not distinguish between specific wavelengths.

We can argue that colors are not real—they are “synthesized” by our brain to distinguish light with different wavelengths. While rods give us the ability to detect the presence and intensity of light (and thus allow our brain to construct the picture of the world around us), specific detection of different wavelengths through independent channels gives our view of the world additional high resolution. For instance, red and green colors look like near identical shades of grey in black and white photos.

An animal with black and white vision alone won’t be able to make a distinction between, let’s say, a green and red apple, and won’t know which one tastes better before trying them both based on color. Evolutionary biologists believe that human ancestors developed color vision to facilitate the identification of ripe fruits, which would obviously provide an advantage in the competitive natural world.

Why certain wavelengths are paired with certain colors remains a mystery. Technically, color is an illusion created by our brain. Therefore, it is not clear if other animals see colors the same way we see them. It is likely that, due to shared evolutionary history, other vertebrates see the world colored similarly to how we see it. But color vision is quite common across the vast animal kingdom: insects, arachnids, and cephalopods are able to distinguish colors.

What kind of colors do these animals see?

Human color vision relies on three photoreceptors that detect primary colors—red, green, and blue. However, some people lack red photoreceptors (they are “bichromates”) or have an additional photoreceptor that detects somewhere between red and green colors (“tetrachromates”). Obviously, having only 3 photoreceptors doesn’t limit our ability to distinguish other colors.

Each photoreceptor can absorb a rather broad range of wavelengths of light. To distinguish a specific color, the brain compares and quantitatively analyses the data from all three photoreceptors. And our brain does this remarkably successfully—some research indicates that we can distinguish colors that correspond to wavelength differences of just 1 nanometer.

This scheme works in largely the same way in most higher vertebrate animals that have color vision. Although the ability to distinguish between specific shades varies significantly between the species, with humans having one of the best color distinguishing abilities.

However, invertebrates that have developed color vision (and vision in general) completely independently from us demonstrate remarkably different approaches to color detection and processing. These animals can have a exceptionally large number of color receptors. The mantis shrimp, for instance, has 12 different types of photoreceptors. The common bluebottle butterfly has even more—15 receptors.

Does it mean that these animals can see additional colors unimaginable to us? Perhaps yes. Some of their photoreceptors operate in a rather narrow region of light spectrum. For instance, they can have 4-5 photoreceptors sensitive in the green region of the visual spectrum. This means that for these animals the different shades of green may appear as different as blue and red colors appear to our eyes! Again, the evolutionary advantages of such adaptations are obvious for an animal living among the trees and grasses where most objects, as we see them, are colored in various shades of green.

Researchers tried to test if a more complicated set of visual receptors provide any advantages for animals when it comes to the distinguishing between main colors. The findings show that this is not necessarily the case, at least not for the mantis shrimp. Despite the impressive array of receptors detecting light in a much broader part of the electromagnetic spectrum compared to humans, the shrimp’s ability to distinguish between colors that great in comparison to us. However, they determine the colors fast. This is probably more important for practical purposes, as mantis shrimps are predators. A large number of photoreceptors allows for their quick activation at specific wavelengths of light and thus communicate directly to the brain what specific wavelength was detected. In comparison, humans have to assess and quantify the signals from all three photoreceptors to decide on a specific color. This requires more time and energy.

Apart from employing a different number of photoreceptors to sense light of specific wavelengths, some animals can detect light that we humans are completely unable to see. For example, many birds and insects can see in the UV part of the spectrum. Bumblebees, for instance, have three photoreceptors absorbing in the UV, blue, and green regions of the spectrum. This makes them trichromates, like humans, but with the spectral sensitivity shifted to the blue end of the spectrum. The ability to detect UV light explains why some flowers have patterns visible only in this part of the spectrum. These patterns attract pollinating insects, which have an ability to see in this spectral region.

A number of animals can detect infrared light (the long wavelength radiation) emitted by heated objects and bodies. This ability significantly facilitates hunting for snakes that are usually looking for small warm-blooded prey. Seeing them through IR detecting receptors is, thus, a great tool for slow-moving reptiles. The photoreceptors sensitive to IR radiation in snakes are located not in their eye but in “pit organs” located between the eyes and nostrils. The result is still the same: snakes can color objects according to their surface temperature.

As this brief article shows, we humans can see and analyze only a small portion of the visual information available to other creatures. Next time you see a humble fly, think about how different it perceives the same things you are both looking at!

We’re living in an age of hyper-connectivity where social media is being widely used by almost every age group in the world. It’s connected people from all corners of the planet and given us the opportunity to have global conversations about practically any subject, event, or news piece.

Psychologists have also observed that social media exacerbates the tendency for frequent users to develop a skewed impression of the world which is seldom accurate or healthy. Young girls and women, for example, may develop unrealistic standards when it comes to their looks and bodies based on what they see on social media.

But instead of labeling social media as the bad guy, I see it as a double-edged sword. The eventual effect that it has on your life really comes down to how you use it and for what purpose. The Internet is a neutral and open platform that levels the playing field when it comes to having access to knowledge that could help us live healthier, productive, and more fulfilling lives.

If anyone wants to avoid the negative impact that social media could have on her self-image, they need to become more conscious of their media diet. If they follow social media accounts and blogs run by people and institutions that are shallow and appearance-focused, such as Instagram models and celebrity fashion and gossip related profiles, it can hurt them if they aren’t mindful of its probable impact on them, especially on a subconscious level.

The negative impact of social media can be avoided if people are guided towards adopting a more empowering and all-encompassing standard of beauty which includes all aspects of being—intellect, aspirations, passions, talents and her morals.

In this way, they will be naturally drawn towards developing an identity that isn’t solely based on outward appearances but on character—this, in turn, will influence the use of social media for noble purposes that will expand the mind and provide a platform to express creative potential and to make a difference. In other words, we need to take an inside-out approach when it comes to combating the potentially harmful effects of social media, or any other forms of media.

In an ironic turn, the recent controversy surrounding Facebook and Cambridge Analytica eclipsed another controversy brewing months before. As 2017 came to close, the million-dollar question surrounding the company was, Does Facebook make us depressed?

Back in December, even Facebook itself posted an article on its official blog, titled, Hard Questions: Is Spending Time on Social Media Bad For Us? The post cites a number of studies that prove spending time on Facebook can threaten well-being.

One study from the University of San Diego and Yale found that people who clicked on four times as many links or liked twice as many posts as the average person reported decreased mental health in a survey. A broader study found that increases in “likes clicked,” “links clicked,” or “status updates” was associated with decreases in mental health.

But though these studies might prove that Facebook brings us down, they don’t ask the important question of how Facebook brings us down. For a more thorough dive into what truly addict us to the site, ultimately leaving us feeling unsatisfied, check out this video, which explains the subject in depth:

The video presents arguments from two former employees, Sean Parker and Chamath Palihapitiya, who claim that Facebook was designed to prey on its users’ neurochemical reward systems. Dopamine, the chemical released in the brain during certain activities, such as exercising, finishing tasks at work, and finding food, has also been found to surge during social interactions. The brain desires cooperation and connection, so it sends reward signals in the form of dopamine when this cooperation or connection occurs. It could be something as simple as carrying a couch up a flight of stairs with a friend, or as profound as telling your partner you love her.

Because the brain cannot distinguish between, an interaction in real life and one on Facebook in terms of dopamine release, these rewards systems are integral to Facebook’s interface. Even the little red notification, or the ping sound we’ve all become accustomed to, produce a similar dopamine release.

The key insight in the video is that Facebook knows these dopamine hits are essential to their business model, the main driving force bringing people back to the site over and over and over again. Knowing this, they’ve ramped up notifications over the years, spiking our dopamine levels for something as mundane and uninteresting as someone having gone “live” a few hours ago, or a belated birthday, or even just to tell you that you haven’t posted in a while.

What happens, then, is a uniquely modern phenomenon. Your brain is rewarding you with dopamine for a successful social interaction, but in reality, no genuine connection has occurred, creating a disconnect between the chemical reward system in your brain and your actual lived experience.

Obviously, Facebook can depress its users in a number of ways. People often assume others’ lives are happier than theirs because of how their friends present themselves online. Teen brains are now trained to be distracted based on the interface alone. But this feeling, the dopamine hit followed by immediate disappointment with the reality of a meaningless notification, seems central to the deflating feeling Facebook can produce.